WPS Health Insurance

What WPS Health Insurance does

WPS Health Insurance, legally Wisconsin Physicians Service Insurance Corporation, is a not-for-profit health insurer founded in 1946 in Madison, Wisconsin in response to post-World War II healthcare needs. The company serves more than 165,000 members across four primary commercial product lines: Medicare Supplement (Medigap) plans, Individual and Family PPO health plans, Short-Term Health Insurance, and Group Health Insurance (both fully-insured and self-funded). The parent organization also operates two large-scale government administrative divisions: WPS Government Health Administrators, which administers Medicare Part A and Part B benefits for multiple states, and WPS Military and Veterans Health, which administers the TRICARE program for active-duty and retired military personnel and their families. Operating subsidiaries include The EPIC Life Insurance Company (Medicare supplement plans in select states) and WPS Health Plan, Inc. (HMO and point-of-service plans based in Green Bay serving eastern and north-central Wisconsin).

The company's delivery architecture combines a Wisconsin-centric WPS Statewide Network covering all 72 counties with 65,000+ doctors and 200+ hospitals alongside the First Health Wrap Network providing out-of-state access to 1,100,000+ providers and 6,500+ hospitals in 49 states. Member-facing services are assembled through third-party integrations rather than in-house technology: Teladoc Health for telehealth, Express Scripts for pharmacy benefit management, Delta Dental for dental, EyeMed for vision discounts, TruHearing for hearing discounts, American Specialty Health's Active&Fit Direct for fitness ($28/month plus enrollment), Omada for Prevention for wellness, Edgepark for DME such as breast pumps, and Auxiant for ASO administration. WPS maintains a CMS-mandated Patient Access API for claims, clinical, and pharmacy data, and supports HIPAA, URAC, CCPA, GDPR, and HITECH compliance frameworks. Underlying technology, proprietary IP, and AI/ML capabilities are not disclosed in available source data.

WPS monetizes primarily through recurring health insurance premiums from individuals, families, employers, and Medicare beneficiaries across the four commercial product lines, and through managed services revenue from federal government administrative contracts (Medicare Part A/B and TRICARE). Distribution is multi-channel: licensed insurance agents and brokers, direct-to-consumer online quoting on wpshealth.com, phone-based sales (800-332-1398), self-service member and employer portals, and the Federally Facilitated Marketplace for individual enrollment. Premium pricing is not publicly disclosed and varies by demographics, plan selection, age, location, and coverage level; add-on programs such as Active&Fit Direct carry a separately disclosed monthly fee.

Name

WPS Health Insurance

Legal name

Wisconsin Physicians Service Insurance Corporation

Website

https://wpshealth.com

Company type

Private

Founded year

1946

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

WPS Health Insurance is a not-for-profit Wisconsin-based health insurer founded in 1946 serving 165,000+ commercial members through Medicare Supplement, Individual/Family PPO, Short-Term, and Group plans, while its parent administers Medicare Part A/B and TRICARE contracts at national scale.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321), Life Insurance (6311)

akta.pro primary industry

Small Group Health Insurance (2–50/100) (FSAIAFAD)

akta.pro secondary industries

High-Deductible Health Plans (HDHP) with HSA-Eligible Coverage (FSAIAFAM), Small Group POS Plans (HLAEAOAI), Flexible Benefits Administration (FSA/HSA/HRA) (HLAEALAK)

Keywords

• Health insurance plans
• Medicare supplement insurance
• Group health insurance
• Government health administration
• Individual family PPO plans

Headquarters

HQ city

Madison

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Health Insurance Premiums: WPS generates revenue primarily through收取健康保险保费 from individuals, families, employers, and Medicare beneficiaries. Premium revenue comes from Medicare Supplement plans, Individual & Family PPO plans, Short-Term Health plans, and Group Health plans. Premiums are paid on a recurring basis (monthly or as specified in policy terms) and represent the core revenue stream for the organization.
2. Government Administrative Services: WPS Government Health Administrators generates revenue by providing administrative services for the U.S. government, including Medicare Part A and Part B benefits management for multiple states, and TRICARE administration for military personnel and their families through WPS Military and Veterans Health.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

WPS Health Insurance is a not-for-profit health insurer that offers Preferred Provider Organization (PPO) health plans for individuals, families, employers, and Medicare beneficiaries. Core products include Medicare Supplement (Medigap) insurance, Individual & Family PPO health plans (including HSA-qualified high-deductible options), Short-Term Health Plans, and Group Health Insurance (fully insured and self-funded). The organization also administers Medicare Part A and Part B benefits and the TRICARE program for military personnel and veterans through its WPS Government Health Administrators division.

Product overview

WPS Health Insurance (Wisconsin Physicians Service Insurance Corporation) is a not-for-profit health insurer offering a comprehensive portfolio of health insurance products and administrative services. The core offerings include Medicare Supplement Plans, Individual and Family PPO Health Plans, Short-Term Health Plans, and Group Health Insurance Plans (both fully-insured and self-funded). The company operates through multiple divisions: WPS Health Insurance (PPO plans), WPS Health Plan (HMO/POS plans based in Green Bay), and The EPIC Life Insurance Company (Medicare supplement in select states). Government services include WPS Government Health Administrators (Medicare Part A/B administration) and WPS Military and Veterans Health (TRICARE). Supplementary services include telehealth through Teladoc Health, pharmacy benefit management through Express Scripts, and value-added programs including vision, hearing, fitness, and wellness discounts. The company serves more than 165,000 members across these products.

Differentiator

Problem solved

Functional benefit

Products and services

• WPS Medicare Supplement Plans

Named customers4 records

Segments4 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration11 records

Partnerships

Ten partnerships are on record, tiered core and supporting.

• Teladoc HealthcoreTechnology or IntegrationTeladoc Health provides telehealth services to WPS individual and fully-insured group health plan customers. Board-certified doctors are available 24/7 via phone or video through the Teladoc Health app or website (teladochealth.com). Services include general medical consultations, mental health services, dermatology services, and Primary360 primary care access.
• Express ScriptscoreTechnology or IntegrationExpress Scripts serves as the Pharmacy Benefit Manager (PBM) for WPS health plans, managing prescription drug benefits including formulary, prior authorization, home delivery pharmacy services, and drug utilization reviews. Customers access prescription services through express-scripts.com.
• Delta DentalsupportingTechnology or IntegrationOptional dental insurance offered through Delta Dental for Individual & Family health plan customers, providing access to dental coverage as an add-on benefit.
• EyeMed Vision CaresupportingTechnology or IntegrationEyeMed provides vision care discount program at no additional cost to WPS customers, offering access to discounted vision services and eyewear through the EyeMed network.
• TruHearingsupportingTechnology or IntegrationTruHearing provides hearing discount program at no additional cost for WPS group and individual customers, offering discounted hearing aids and hearing care services.
• Omada HealthsupportingStrategic or Co-development PartnerWPS partnered with Express Scripts and Omada for Prevention to provide a personalized program giving members tools and support to reach health goals at no extra cost. Available only if Express Scripts is the Pharmacy Benefit Manager.
• American Specialty Health (ASH)supportingTechnology or IntegrationAmerican Specialty Health Fitness, Inc. (ASH) provides the Active&Fit Direct program offering access to 10,000+ participating fitness centers and YMCAs for $28/month. ASH is a subsidiary of American Specialty Health Incorporated.
• First HealthcoreTechnology or IntegrationFirst Health Wrap Network provides nationwide provider network coverage outside Wisconsin, offering access to 1,100,000+ doctors, 6,500+ hospitals, and 147,000+ ancillary facilities in 49 states.
• AuxiantsupportingTechnology or IntegrationAuxiant provides the ASO (Administrative Services Only) platform powering WPS Employer Enrollment/Reporting for self-funded groups, enabling employers to manage benefits administration.
• Livanta (Quality Improvement Organization)supportingOthersLivanta serves as the Quality Improvement Organization (QIO) for Wisconsin, handling quality of care complaints for Medicare beneficiaries under the Part D prescription drug plan.

Scale indicators10 records

Recent moves6 records

Expansion highlights6 records

Others

• Aetna (CVS Health):

Direct peers

• Security Health Plan: Wisconsin-based regional health plan offering HMO, PPO, and Medicare Advantage plans to individuals, families, and employers — a direct competitor in WPS's core Wisconsin market with comparable product mix and provider network strategy.
• Quartz Health Solutions: Wisconsin-headquartered health plan offering commercial and Medicare products through regional provider systems; competes head-to-head with WPS for Wisconsin group and individual customers with a similar regional carrier model.
• MercyCare Health Plans: Wisconsin-based health insurer affiliated with Mercyhealth, offering group and individual plans in southern Wisconsin and northern Illinois — competes directly with WPS for Wisconsin employer group business.
• Dean Health Plan: Wisconsin-anchored health plan (part of SSM Health) offering commercial HMO/POS products and Medicare Advantage in south-central Wisconsin; directly competes with WPS in overlapping service areas.

Broad incumbents

• Blue Cross Blue Shield of Wisconsin (Anthem): Anthem's Wisconsin Blue Cross Blue Shield licensee offers the broadest commercial and Medicare footprint in the state, providing direct competition in group, individual, and Medicare Supplement markets where WPS also operates.
• UnitedHealthcare: Largest U.S. health insurer with significant Wisconsin employer group, individual ACA Marketplace, and Medicare Supplement presence; competes with WPS on scale, network breadth, and pricing across all WPS product lines.
• Humana: Major Medicare-focused insurer with strong Medicare Supplement and Medicare Advantage presence nationally, including Wisconsin; competes with WPS's core Medigap franchise on broker relationships and brand recognition among seniors.
• Cigna Group Insurance: National health services company with commercial group and individual plan offerings; competes with WPS in Wisconsin employer group market with broader portfolio including stop-loss, behavioral, and pharmacy.

Regional players

• HealthPartners: Upper-Midwest integrated health plan (Minnesota/Wisconsin) with HMO, PPO, and Medicare products; serves as a structural analog to WPS as a regional, not-for-profit insurer with multi-state group capabilities.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/WPSHealth
• LinkedInlinkedin.com/company/wps-health-insurance

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Subsidiaries2 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about WPS Health Insurance